Judge, doctors speak in support of medication-assisted treatment at opioid summit

INDIANAPOLIS — Hundreds of criminal justice professionals tasted the cruel reality of the state’s opioid crisis when Marion Superior Court Judge William Nelson played a chilling 911 call from a mother who had just found her 20-year-old son dead from an overdose.

The 90-second recording of the despondent and sobbing woman filled the ballroom at the Indiana Convention Center Wednesday morning at the start of a statewide opioid summit called “A Medication-Assisted Treatment and Addictions Primer for Justice Professionals.”

Eyes welled. Middle-aged men removed their glasses and brushed away tears. No one spoke as the mother wailed.

“My wife made that call,” said Nelson, a judge the past 25 years.

“Let’s hear today how to treat substance abuse disorder, a chronic brain disease, not a crime,” the judge said to representatives from all 92 Indiana counties. “Maybe we can prevent one mother from making that call, in this seemingly endless battle.”

A decade ago, Nelson said, he saw drug abuse as a crime and a moral failure and would have said people choose to take drugs and should be held accountable and punished. He didn’t believe in medication-assisted treatment, called MAT, claiming it substituted one drug for another.

His perspective changed on June 14, 2009, the day his stepson died. Nelson now understands and supports MAT as a tool to stop what he calls “a national health crisis that does not play favorites.”

On an average day, Nelson said, 115 Americans die from opioid overdoses.

Leslie Hulvershorn, a physician who works with the Family and Social Services Administration and Indiana University’s School of Medicine, said that in 1990, the total number of opioid overdose deaths was 7,000. Now, she said, it’s close 52,000 a year.

During the morning, four experts spoke about how addiction affects and changes the brain, explaining how using medication as part of treatment is effective in treating opioid use disorder and other addictions. There also was discussion about the legal implications of medication-assisted treatment and the role the court system plays in making it work.

Andrew Chambers, a doctor at IU’s medical school, explained how substance abuse disorder is a medical condition that changes the brain and affects 20 percent of adults in the United States. Amid talk of dopamine, the nucleus accumbens and motivational neurocircuitry, he drove home his message: substance abuse and addiction are medical disorders that are deep and profound in society today.

“It’s a progressive, neuropsychiatric disease, like Alzheimer’s or Parkinson’s,” he said, “based on many biological factors.”

The experts explained how mental illness is a key component in the addiction crisis. “An untreated addiction and mental illness epidemic — that’s what this really is,” Chambers said.

While often controversial, medication-assisted treatment, whether it’s an opioid-based drug or one that blocks the brain’s opioid receptors, is the best treatment path, since the chance of relapse without it is between 80 and 90 percent. Speakers urged law enforcement officials in the audience to get past concerns over MAT if they want to turn around, and save, lives.

“The odds are really stacked against you without MAT,” said Hulvershorn, estimating that about 15,000 Indiana residents currently are receiving medication to treat their opioid addiction.

“It’s effective, evidence-based treatment,” she said. “It’s unbelievable that we don’t offer it to everyone. It’s like withholding chemotherapy from cancer patients.”

Among the summit participants from Monroe County were Judge Mary Ellen Diekhoff, who oversees drug court; Bloomington Police Chief Mike Diekhoff; Linda Brady, Susan Allen and Steve Malone from the probation department; Linda Grove-Paul from Centerstone; and Kyle McGlone from the county’s Department of Child Services.